TY  - JOUR
AU  - Fuentes Casan, Manuel
AU  - Klostermann, Arne
AU  - Kleineidam, Luca
AU  - Bauer, Chris
AU  - Schuchhardt, Johannes
AU  - Maier, Wolfgang
AU  - Jessen, Frank
AU  - Frölich, Lutz
AU  - Wiltfang, Jens
AU  - Kornhuber, Johannes
AU  - Klöppel, Stefan
AU  - Schieting, Vera
AU  - Teipel, Stefan J.
AU  - Wagner, Michael
AU  - Peters, Oliver
TI  - Identification of a Cascade of Changes in Activities of Daily Living Preceding Short-Term Clinical Deterioration in Mild Alzheimer’s Disease Dementia via Lead-Lag Analysis
JO  - Journal of Alzheimer's disease
VL  - 76
IS  - 3
SN  - 1875-8908
CY  - Amsterdam
PB  - IOS Press
M1  - DZNE-2020-01339
SP  - 1005 - 1015
PY  - 2020
AB  - Background:Cognitive functions and activities of daily living (ADL) become increasingly impaired with progressing Alzheimer’s disease. However, the temporal dynamics of this decline are inconsistent.Objective:To gain insight into the classical temporal cascade of specific cognitive and ADL changes, which may aid in improving detection of an impending clinical deterioration in patients, and to select ADL items and tests most sensitive to change in a specific disease stage.Methods:Patients with mild Alzheimer’s dementia (AD; MMSE = 23.9±2.88) were followed at 12 and 24 months. Lead-lag analysis of changes in cognitive and functional outcome measures (CDR-SOB, 12 neuropsychological subtest scores from the CERAD + test battery, 25 Bayer-ADL items) was applied to rank the temporal sequence of changes on an ordinal scale.Results:Of 164 patients with mild AD, moderate disease progression was identified in 84 patients over 24 months (ΔMMSE 5.8±8.64; ΔCDR-SOB 4.32±4.03). Ten Bayer-ADL item measures were altered early in moderate progressors and included in a new ADL composite score. Accordingly, the new ADL score surpassed all neuropsychological measures in repeated lead-lag analysis. The Bayer-ADL total score, TMT-A, and MMSE were lagging variables in all lead-lag analyses.Conclusion:Short-term clinical deterioration in mild AD is initially preceded by changes (i.e., decline) in a well-defined set of ADL and not in classical cognitive measures.
KW  - Activities of Daily Living: psychology
KW  - Aged
KW  - Alzheimer Disease: psychology
KW  - Clinical Deterioration
KW  - Cognition: physiology
KW  - Disease Progression
KW  - Female
KW  - Humans
KW  - Male
KW  - Neuropsychological Tests
KW  - Time Factors
LB  - PUB:(DE-HGF)16
C6  - pmid:32597807
C2  - pmc:PMC7504993
DO  - DOI:10.3233/JAD-200230
UR  - https://pub.dzne.de/record/153342
ER  -